Provider Demographics
NPI:1508398421
Name:MCKINNIS, LYNN (PT,DPT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:MCKINNIS
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RENAISSANCE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-7612
Mailing Address - Country:US
Mailing Address - Phone:724-256-9606
Mailing Address - Fax:724-256-9609
Practice Address - Street 1:200 RENAISSANCE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-7612
Practice Address - Country:US
Practice Address - Phone:724-256-9606
Practice Address - Fax:724-256-9609
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003932L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist